Effect of Home Monitoring via Mobile App on the Number of In-Person Visits Following Ambulatory Surgery: A Randomized Clinical Trial

Abstract

Importance: In the age of information and patient-centered care, new methods of delivering postoperative care must be developed and evaluated.

Objective: To determine whether follow-up care delivered via a mobile app can be used to avert in-person follow-up care visits compared with conventional, in-person follow-up care in the first 30 days following ambulatory surgery.

Design, setting, and participants: A randomized clinical trial was conducted from February 1 to August 31, 2015, among ambulatory patients undergoing breast reconstruction at an academic ambulatory care hospital. Patients were randomly assigned to receive follow-up care via a mobile app or at an in-person visit during the first 30 days after the operation. Analysis was intention-to-treat.

Main outcomes and measures: The primary end point was the number of in-person follow-up visits during the first 30 days after the operation. Secondary end points were the number of telephone calls and emails to health care professionals, patient-reported convenience and satisfaction scores, and rates of complications.

Results: Of the 65 women in the study (mean [SD] age, 47.7 [13.4] years), 32 (49%) were in the mobile app group, and 33 (51%) were in the in-person follow-up care group. Those in the mobile app group attended a mean of 0.66 in-person visits, vs 1.64 in-person visits in the in-person follow-up care group, for a difference of 0.40 times fewer in-person visits (95% CI, 0.24-0.66; P < .001) and sent more emails to their health care professionals during the first 30 days after the operation (mean, 0.65 vs 0.15; incidence rate ratio, 4.13; 95% CI, 1.55-10.99; P = .005) than did patients in the in-person follow-up care group. This statistically significant difference was maintained at 3 months postoperatively. The mobile app group reported higher convenience scores than the in-person follow-up care group (incidence rate ratio, 1.39; 95% CI, 1.09-1.77; P = .008). There was no difference between groups in the number of telephone communications, satisfaction scores, or complication rates.

Conclusions and relevance: Patients undergoing ambulatory breast reconstruction can use follow-up care via a mobile app to avert in-person follow-up visits during the first 30 days after the operation. Mobile app follow-up care affects neither complication rates nor patient-reported satisfaction scores, but it improves patient-reported convenience scores.

Trial registration: clinicaltrials.gov Identifier: NCT02318953.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Semple reported holding shares in QoC Health Inc. No other disclosures were reported.

Figures

Figure 1.. Flow Diagram of Study Recruitment

aWhen questioned, the patients’ reasons for declining participation after randomization were unclear.

Figure 2.. Satisfaction Scores Between Groups

Patients’ responses to the question, “Were you satisfied with the type of follow-up care (mobile app or in-person) you received?

Figure 3.. Convenience Scores Between Groups

Patients’ responses to the question, “Would you describe the type of follow-up care (mobile app or in-person) you received as convenient?”